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CLINICAL RESEARCH: CARDIOVASCULAR EFFECT OF SLEEP APNEA

Obstructive Sleep Apnea Syndrome

More Insights on Structural and Functional Cardiac Alterations, and the Effects of Treatment With Continuous Positive Airway Pressure

Department of Cardiology and Pulmonary Medicine, University Hospital Antwerp, Antwerp, Belgium.

Manuscript received July 14, 2005; revised manuscript received October 10, 2005, accepted November 8, 2005.

^_* Reprint requests and correspondence: Dr. Bharati Shivalkar, Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. (Email: bharati.shivalkar{at}skynet.be).

Presented in part at the European Society of Cardiology, Vienna, August 2003, and the Euroecho Scientific Sessions, Athens, Greece, December 2004.

OBJECTIVES: We studied structural and functional cardiac alterations in obstructive sleep apnea (OSA), their relationship to the severity of OSA, and the effects of treatment with continuous positive airway pressure (CPAP).

BACKGROUND: Obstructive sleep apnea may influence the cardiac function by several mechanisms in the awake patient.

METHODS: Left and right ventricular morphology and function were studied using echocardiography before and after treatment with CPAP in symptomatic patients (Epworth sleepiness score, 10 ± 4.8) with severe OSA (apnea-hypopnea index [AHI], 42 ± 24). The patients (n = 43, 32 men) had no known cardiac disease and were obese (body mass index, 31.6 ± 5.4 kg/m²). The same echocardiographic parameters were studied in age-matched overweight patients (n = 40; body mass index, 26.4 ± 2.3 kg/m²).

RESULTS: The patients were hypertensive (systolic blood pressure, 153 ± 25 mm Hg), with a higher resting heart rate (77 ± 10 beats/min, p = 0.008) compared with age-matched control patients (n = 40). There was right ventricular dilatation, hypertrophic interventricular septum, reduced left ventricular stroke volume, tissue Doppler-determined systolic and diastolic velocities of the left and right ventricle, and normal pulmonary artery pressure. The structural and functional parameters were significantly associated with AHI (p < 0.004). Multiple stepwise regression showed the interventricular septum thickness, right ventricular free wall, and mitral annulus tissue Doppler systolic velocities to be predictive of a higher AHI (p < 0.001). Six months after treatment with CPAP, significant improvements were observed in the symptoms and hemodynamics, as well as left and right ventricular morphology and function.

CONCLUSIONS: The structural and functional consequences of OSA on the heart are influenced by the severity of AHI. These effects are reversible if the apneic episodes are abolished.

Abbreviations and Acronyms   AHI = apnea-hypopnea index   BMI = body mass index   CPAP = continuous positive airway pressure   EEG = electroencephalogram   ESS = Epworth sleepiness scale   OSA = obstructive sleep apnea

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